In a study just published in Social Science & Medicine, a research team led by Michael Palmer at the University of Melbourne and including Fordham’s Dr. Sophie Mitra and Daniel Mont and Nora Groce both of University College London evaluates the impact of a health insurance program targeted at children under age six in Vietnam.
Public health insurance programs are growing popular in low and middle-income countries. In general, their aim is to enhance financial protection and equity related to health care. Health insurance programs targeted at children are not very common and it is important to evaluate their impacts. If they improve the health of children, such programs could have lifelong benefits in terms of improved wellbeing and productivity. These programs are smaller than universal health insurance programs (for the entire population) and may be more feasible to adopt as countries try to expand health insurance coverage.
Countries such as the Philippines, Taiwan and Vietnam have introduced child-targeted health insurance programs. Vietnam’s public health insurance program has a long history dating back to 1986. Its program targeted at children under age six was implemented in 2005. This paper evaluates the impact of this program on children’s health care utilization (total, public and private services) and on health expenditures at the household level.
The authors use a sample of children from three cross-sections of the Vietnam Household Living Standard Survey (2006, 2008 and 2010). This paper overcomes some estimation problems and biases found in previous studies. The authors apply a fuzzy Regression Discontinuity (RD) design to a large unrestricted sample of children, which helps address heterogeneity.
Results show that the child health insurance program for children under age six increases the probability of inpatient visits by 6.8% and of outpatient visits by 21.7%. This is illustrated in the Figure 1 below, with a higher predicted probability of inpatient or outpatient visit for children under age six. The impact of insurance on health expenditures is not statistically significant, which suggests that the policy was not successful at significantly providing financial protection.
The authors do not find any evidence of substitution of public for private health care, which suggests that barriers to entry exist at covered public care facilities. This could be due to a variety of factors, including long queues and lack of trust in public health care. Results for substitution effect point out the significance of engaging the private sector, as it is major source of health care in Vietnam as well as in many African and Asian countries. Possible reforms include scaling up efforts to register of private health care providers into the health insurance system and the improvement of standards (both administrative and health care) of the public health care system.
Overall, the results of this paper suggest that in Vietnam, the child health insurance program for children under age six was successful at improving children’s health care access for both inpatient and outpatient services. This evidence is significant for policy makers in other LMIC’s.
Palmer, Michael and Mitra, Sophie and Mont, Daniel and Groce, Nora, The Impact of Health Insurance for Children Under Age 6 in Vietnam: A Regression Discontinuity Approach (October 20, 2014). Palmer, M., Mitra, S. et al., The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach, Social Science & Medicine (2014), Forthcoming. Available at
http://ssrn.com/abstract=2512608 or http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2512608